OBJECTIVE: The purpose of this study is to design the web-based dialogue expert system for preventing and managing of habitual substance disorders in adolescents. METHODS: Research process includes the requirement analysis, making of questionnaires, actual survey, and its analysis. Based on the analysis, we designed the web-based dialogue expert system. RESULTS: The habitual substance disorders in adolescents are variable. Our system for managing habitual substance disorders contains the diagnosis of alcoholism, nicotinism, and narcotism. And it analyzes the facts of them based the questionnaires and answer. As the results of the analysis, main reasons in order of the power of influence are belief, will of refusal, personal characteristics, family environment, and psychological personality. Our system suggests the customized solution to conquer that for each adolescent. Moreover, our system also includes the history tracking mechanism to manage the status of each teenager constantly and to make the survey and analysis information. CONCLUSION: With our system, young boys and girls can know their seriousness of alcoholism, nicotinism, and narcotism. And they can get all possible helps through our system. This system will be the interactive and familiar way that anyone all over the world can use for overcoming problems.
Adolescent* ; Alcoholism ; Diagnosis ; Disulfiram ; Expert Systems ; Factor Analysis, Statistical* ; Family Characteristics ; Female ; Humans

PURPOSE: Tacrolimus (FK-506) represents a major advance in the prevention of rejection following solid organ transplantation. Previous clinical trials in Japan, Europe, and the US suggest that tacrolimus is an effective primary immunosuppressive agent in kidney transplantation. This prospective, non-randomized single center study was done to confirmed the efficacy of tacrolimus in kidney transplantation. METHODS: A total of 50 renal transplant recipients who followed-up at least one year after transplantation was included in this study. Thirty six cases (72%) recived triple drug therapy consists of tacrolimus, mycophenolate mofetil (MMF), and low dose steroid. RESULTS: The overall incidence of acute rejection was 10%, all episodes of rejection were treated effectively with steroid pulse therapy. The incidence of treatment failure was six percent. One and two year graft survival were 98% and 96%, respectively. Adverse effects of tacrolimus therapy included tremor of the hand (56%), diarrhea (34%), alopecia (26%), hyperkalemia (22%), nephrotoxicity (18%), post transplant diabetes mellitus (14%), hypertension (14%), and hypercholesterolemia (10%). However, the incidence of gum hypertrophy and hirsutism were 6% and 2%, respectively. CONCLUSION: This short-term study indicates that tacrolimus appears to provide safe and effective primary immunosuppression in kidney transplantation.
Alopecia ; Diabetes Mellitus ; Diarrhea ; Drug Therapy ; Europe ; Gingiva ; Graft Survival ; Hand ; Hirsutism ; Hypercholesterolemia ; Hyperkalemia ; Hypertension ; Hypertrophy ; Immunosuppression* ; Incidence ; Japan ; Kidney Transplantation* ; Organ Transplantation ; Prospective Studies ; Tacrolimus* ; Transplantation ; Transplants ; Treatment Failure ; Tremor

Autosomal polycystic kidney disease is responsible for about 10% of the cases of end stage renal disease. The increase in kidney size is usually proportional to the degree of deterioration in renal function. At the time of transplantation, these nonfunctional kidneys can be massively enlarged and nephrectomy is required before renal transplantation. However, pretransplantation nephrectomy of polycystic kidneys has the potential risk of surgical complications, including ileus, hernias, infection, excessive bleeding and/or intestinal injury. We report here on two cases successful renal transplantation in patients with polycystic kidneys after renal contraction by renal artery embolization and without nephrectomy. The volume reduction was evaluated by CT before and 3 months after renal artery embolization and the reduction in volume was 48% and 44% in each case, respectively. The embolization was well tolerated in both cases without immediate or delayed complications except for fever and lumbar flank pain. Four months after renal artery embolization, both of the patients successfully received a transplant from living donors.
Contracts ; Fever ; Flank Pain ; Hemorrhage ; Hernia ; Humans ; Ileus ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Living Donors ; Nephrectomy ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Dominant ; Renal Artery ; Transplants

Hypoxia-induced cell damage is known to be mediated by increase in intracellular calcium. In the present study, the effect of calcium channel blockers on the hypoxia-induced cell damage was investigated in iat pheochromocytoma cells line, PC12 cells. The cultured cells were exposed to hypoxia under 95% N2 plus 5% C02 gas phase and incubated in the media devoid of fetal bovine seruril The cell demage was assessed by measuring the release of lactate dehydrogenase (LDH) from the cells into the incubation media. Exposure of the cells to hypoxia for 2 hours caused a 28% of the total LDH to be released from cells -into media. The pretreatment of the cells with 1 mM each of diltiazem, nifedipine, and verapamil depressed the LDH release to the extent of 52%, 42%, and 30% inhibition, respectively. The inhibitory effects of diltiazem and verapamil were more marked at 1 mM than at 10 mM. The influx of 45 Ca2+ into the cells was rapidly increased within 2 minutes after exposure of the cells to hypoxia. Diltiazem at 1 mM almost completely inhibited Ca2+ influx, while nifedipine and verapamil exhibited only, 30% inhibition of Ca2- influx. The results lend support to the notion that mcreased intracellular calcium triggers a series of cascade reactions leadmg to cell death. It is suggested that the inhibitory effects of various calcium antagonists on hypoxia-induced cell damage differ from each other in their potency.
Animals ; Anoxia* ; Calcium Channel Blockers ; Calcium* ; Cell Death ; Cells, Cultured ; Diltiazem ; L-Lactate Dehydrogenase ; Nifedipine ; PC12 Cells* ; Pheochromocytoma ; Verapamil

Infectious complications are the leading causes of morbidity and mortality among kidney transplant recipients. Infective endocarditis has been reported as a rare complication in kidney transplant recipients and substantially impacts kidney transplant recipient survival. The early diagnosis of endocarditis is essential in order to initiate appropriate antibiotic treatment. In selected cases, surgery can be undertaken to prevent significant subsequent morbidity and mortality. We report a case of subacute bacterial endocarditis due to beta- hemolytic streptococcus in a 25-year-old kidney transplant recipient, which was successfully treated with antibiotics and valve annuloplasty.
Adult ; Anti-Bacterial Agents ; Early Diagnosis ; Endocarditis* ; Endocarditis, Subacute Bacterial ; Humans ; Kidney ; Kidney Transplantation ; Mortality ; Streptococcus ; Transplantation*

BACKGROUND: Peritonitis is one of the major complication leading to mortality and technique failure in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We have examined the incidence and etiology of CAPD peritonitis at Keimyung University Dongsan medical center. METHODS: Between January 1996 and December 2000, 238 new patients received peritoneal dialysis and were reviewed retrospectively. RESULTS: In 238 patients, 109(45.8%) patients experienced peritonitis and a total of 192 episodes of peritonitis has occurred during study period. The overall incidence of peritonitis during CAPD averaged 0.94/patient-year and there was no essential change during the last five years. The most common causative organism was Gram positive organism (41.7%), followed by Gram negative organism (14.1%), and fungus (2%). In Gram positive organism, Staphylococcus aureus (47.5%) was the most common microorganism, followed by coagulase negative Staphylococcus (23.5%), Streptococci (7.5%), and Enterococci (5.5%). Gram negative organism were Acinetobactor (29.6%), Escherichia coli (18.5%), Klebsiella (18.5%) and Pseudomonas (7.4%) in decreasing order of frequency. With the use Bactec blood culture system for peritoneal fluid culture since April 2000, the culture yield has been improved significantly than before (52.5% vs 72.2%, p < 0.05). Peritonitis was cured in 164 cases (85.6%) with the administration of antibiotics. However catheters had to be removed in 23 cases (11.8%). Exit-site infection was more frequent in catheter removal group than in catheter retaining group (17.4% vs 4.7%, p < 0.05). The CAPD failure occured in 28 patients during study period, and peritonitis was the major reason for technique failure (82.1%). The catheter removal rate was significantly higher in the patients with peritonitis than those without peritonitis (55.0% vs 30.2%, p < 0.05). There were six deaths during study period. Septicemia associated with peritonitis accounted for the half of the mortality. CONCLUSION: Better exit-site care and continuing patient education is needed the incidence of peritonitis and peritonitis related mortality in CAPD patient.
Anti-Bacterial Agents ; Ascitic Fluid ; Catheters ; Coagulase ; Epidemiology* ; Escherichia coli ; Fungi ; Humans ; Incidence ; Klebsiella ; Mortality ; Patient Education as Topic ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Pseudomonas ; Retrospective Studies ; Sepsis ; Staphylococcus ; Staphylococcus aureus

PURPOSE: Results of the US randomized, comparative, multicenter study demonstrated that tacrolimus (Tac) was equivalent to cyclosporine (CyA) in 1-year patient and graft survival in recipients of cadaveric renal transplants. However, the incidence and severity of acute rejection was significantly lower in Tac-treated patients compared with CyA-treated patients. This retrospective, non-randomized single center study represents results of follow-up to 3 years posttransplant. METHODS: A total of 97 kidney transplant recipients were included; 41 received Tac-based immunosuppression, and 56 received CyA-based immunosuppression and followed for 3 years posttransplant. Serious adverse events were also monitored over 3 years. RESULTS: The three-year patient survival rates were 95.0% and 96.5% for Tac and CyA, respectively (P=NS). Corresponding graft survival rates were 90.2% and 91.0%, respectively (P=NS). However, the incidence of acute rejection was significantly less in the Tac-group compared with the CyA-group (17.1% vs. 35.7%, P=0.043). The rate of crossover was significantly higher in the CyA-group (4.9% vs. 21.4%, P=0.013). Renal function at 3 years was similar in both treatment groups. The incidence of posttransplant diabetes mellitus (PTDM), head-ache and alopecia was significantly less in the CyA-group, and that of hypertension, hypercholesterolemia after transplantation was significantly less in Tac-group. The incidence of hirsutism and gingival hyperplasia was negligible in Tac-group. Incidence of hand tremor, hyperkalemia, bacterial and viral infection, and malignancy was comparable in both groups. The incidence of PTDM was significantly less in CyA-group (26.8% vs. 7.1%, P=0.008). Nine (81.8%) of the 11 Tac patients with PTDM were off of insulin at 3 years. CONCLUSIONS: Tacrolimus is a very effective primary immunosuppressive agent in renal transplant recipient. The reduced incidence of acute rejection along with decreased incidence of hypertension and hyperlipidemia after transplantation suggests potential long-term advantage with the use of this drug.
Alopecia ; Cadaver ; Cyclosporine ; Diabetes Mellitus ; Follow-Up Studies ; Gingival Hyperplasia ; Graft Survival ; Hand ; Hirsutism ; Humans ; Hypercholesterolemia ; Hyperkalemia ; Hyperlipidemias ; Hypertension ; Immunosuppression ; Incidence ; Insulin ; Kidney Transplantation* ; Kidney* ; Retrospective Studies ; Survival Rate ; Tacrolimus* ; Transplantation ; Tremor

INTRODUCTION: Comparing with living donor renal transplantation, cadaveric renal transplantation is usually performed as an emergency procedure and has prolonged preservation time and increased incidence of delayed graft function. Korean Network for Organ Sharing (KONOS) was launched from February 2000 to manage the organ transplantation in Korea and expected to increase donor organs supply and an effective organ allocation. PURPOSE: In order to compare the result of cadaveric renal transplantation before and after KONOS system, 108 cadaveric renal transplants performed in Dongsan hospital until October 2003 were reviewed and analyzed. METHODS: Donors and recipients were divided into two groups (group 1; transplantation performed before KONOS, group 2; transplantation after KONOS) and their characteristics and results were analyzed retrospectively. RESULTS: Among donor factors, number of multi-organ procurement increased (23.1% vs 78.6%), and use of inotrophic agent decreased (63% vs 46%) significantly after KONOS, however cold preservation time was not changed even after KONOS system. Procured organs per one donor in our hospital was increased from 2.25 to 2.65. Increased recipient age (from 30.1 to 41.9 years old), more chance to diabetic patient and decreasing number of HLA mismatching (4.6 to 3.9) were considered as a result of KONOS allocation system. However, early results including incidence of acute rejection episode and delayed graft function, and serum creatinine level at the end of one year were no statistic differences. The number of early graft loss were decreased up to 2 years after transplantation. CONCLUSION: Renal transplantation from cadaveric donor after KONOS resulted in lower early graft loss but increased waiting time due to organ shortage is a serious problem to be solved in the future.
Cadaver* ; Creatinine ; Delayed Graft Function ; Emergencies ; Humans ; Incidence ; Kidney Transplantation* ; Korea ; Living Donors ; Organ Transplantation ; Retrospective Studies ; Tissue Donors ; Transplantation ; Transplants

BACKGOUND: Recurrent peritonitis and catheter-related infection, in which removal of the PD catheter and temporary hemodialysis are required, are the main cause of limited technical survival in peritoneal dialysis (PD). The aim of this study was to verify whether the simultaneous catheter removal and replacement (SRR) is feasible and safe in patients with recurrent peritonitis and catheter-related infection. METHODS: From January 2001 to December 2004, We performed 47 SRR in 42 PD patients for the treatment of recurrent peritonitis and catheter-related infection to avoid the interruption of PD. RESULTS: Indications for SRR were recurrent peritonitis in 16 (34.0%), catheter infection without peritonitis in 16 (34.0%), catheter infection with peritonitis in 11 (23.5%) and peritonitis with dialysate leakage in 4 (8.5%). SRR was successful in 89.4%. However, SRR was failed in 10.6% due to persistent tunnel infection in three, drainage failure and hernia in each one. PD was continued after SRR during 14.5+/-11.8 months and subsequent catheter longevity ranged from 3 to 47 months. The most common causative organism of recurrent peritonitis and catheter-related infection was MRSA (25.5%). Subsequent peritonitis occurred in 52.4% of patients with the mean of 10.5+/-9.6 months after SRR. However, 81.8% of subsequent peritonitis were due to new organisms. Postoperative complications occurred in 16 cases (34.0%) including five cases with dialysate leakage, four with persistent tunnel infection, four with early peritonitis, two with drainage failure and one with bleeding. CONCLUSION: We conclude that SRR is a safe and effective procedure in patients with recurrent peritonitis and catheter-related infection without the interruption of PD.
Catheter-Related Infections* ; Catheters* ; Drainage ; Hemorrhage ; Hernia ; Humans ; Longevity ; Methicillin-Resistant Staphylococcus aureus ; Peritoneal Dialysis* ; Peritonitis* ; Postoperative Complications ; Renal Dialysis

Focal nodular hyperplasia (FNH) is a rare benign hepatic tumor occurring predominantly in women of childbearing age. Generally oral contraceptive is not associated with FNH but might accentuate the vascular abnormalities which may cause the lesion to enlarge and, very rarely, to rupture. FNH is typically asymptomatic and seldom bleeds. Often it is incidentally observed during imaging procedures performed for some other reasons. The histologic feature of FNH is characterized by areas of localized growth of mature hepatocytes and septal fibrosis. Surgical resection is seldom required because of the benign nature of the lesion and its lack of significant complication. We experienced a case of focal nodular hyperplasia without liver cirrhosis confirmed by surgical resection and histologic examination. in a 47-year-old man.
Female ; Fibrosis ; Focal Nodular Hyperplasia* ; Hepatocytes ; Humans ; Liver Cirrhosis ; Liver* ; Middle Aged ; Rupture